Utility of magnetic resonance imaging in the evaluation of patients with inflammatory myopathies

Park, Jane H.; Olsen, Nancy J.

doi:10.1007/s11926-001-0038-x

Cited by 60 publications

(41 citation statements)

References 46 publications

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“…Only muscle biopsy can establish the definite diagnosis [45,46], but muscle inflammation may be spotty and idiopathic inflammatory myopathies range from focal varieties confined to a single muscle to diffuse forms [46]. Thus, MRI has been proposed to better guide a biopsy in an area of active disease [1,24,46,47] given the false-negative rate of 10-25% without imaging guidance [48][49][50]. Whole-body MRI [48] further improves the diagnostic utility.…”

Section: Diagnosismentioning

confidence: 99%

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Quantitative evaluation of muscle perfusion with CEUS and with MR

2007

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Functional imaging might increase the role of imaging in muscular diseases, since alterations of muscle morphology alone are not specific for a particular disease. Perfusion, i.e., the blood flow per tissue and time unit including capillary flow, is an important functional parameter. Pathological changes of skeletal muscle perfusion can be found in various clinical conditions, such as degenerative or inflammatory myopathies or peripheral arterial occlusive disease. This article reviews the theoretical basics of functional radiological techniques for assessing skeletal muscle perfusion and focuses on contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI) techniques. Also, the applications of microvascular imaging, such as in detection of myositis and for discriminating myositis from other myopathies or evaluating peripheral arterial occlusive disease, are presented, and possible clinical indications are discussed. In conclusion, dedicated MR and CEUS methods are now available that visualize and quantify (patho-)physiologic information about microcirculation within skeletal muscles in vivo and hence establish a useful diagnostic tool for muscular diseases.

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Section: Diagnosismentioning

confidence: 99%

“…Also, the clinical relevance of perfusion imaging needs to be further elucidated. In comparison to CEUS, higher costs of MRI, reduced availability, patient discomfort, and exclusion of patients with certain indwelling metals [49] have to be considered.…”

Section: Mrimentioning

confidence: 99%

Quantitative evaluation of muscle perfusion with CEUS and with MR

2007

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“…Most patients have elevated muscle enzymes (ie, creatinine kinase, aldolase, lactate dehydrogenase, or transaminases) 1 ; for those who do not, magnetic resonance imaging can be helpful in detecting muscle involvement and locating the best site for muscle biopsy. 7 Electromyography reveals nonspecific muscle membrane instability. 8 Muscle biopsy shows muscle fiber necrosis, perifascicular atrophy, and perivascular and perifascicular lymphocytic infiltrates.…”

Section: Commentarymentioning

confidence: 99%

“Are we there yet?”

Williams

Raugi

Dhaliwal

et al. 2007

Journal of Hospital Medicine

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The approach to clinical conundrums by an expert clinician is revealed through presentation of an actual patientA 62-year-old man with psoriasis for more than 30 years presented to the emergency department with a scaly, pruritic rash involving his face, trunk, and extremities that he had had for the past 10 days. The rash was spreading and not responding to application of clobetasol ointment, which had helped his psoriasis in the past. He also reported mild pharyngitis, headache, and myalgias.A patient with a chronic skin condition presenting with a new rash means the clinician must consider whether it is an alternative manifestation of the chronic disorder or a new illness. Psoriasis takes many forms including guttate psoriasis, which presents with small, droplike plaques and frequently follows respiratory infections (particularly those caused by Streptococcus). Well-controlled psoriasis rarely transforms after 3 decades, so I would consider other conditions. The tempo of illness makes certain life-threatening syndromes, including Stevens-Johnson, toxic shock, and purpura fulminans, unlikely. An allergic reaction, atopic dermatitis, or medication reaction is possible. Infections, either systemic (eg, syphilis) or dermatologic (eg, scabies), should be considered. Photosensitivity could involve the sun-exposed areas, such as the extremities and face. Seborrheic dermatitis can cause scaling lesions of the face and trunk but not the extremities. Vasculitis merits consideration, but dependent regions are typically affected more than the head. Mycosis fungoides or a paraneoplastic phenomenon could cause a diffuse rash in this age group.The patient had diabetes mellitus, hypertension, diverticulosis, and depression. Three months earlier he had undergone surgical drainage of a perirectal abscess. His usual medications were lovastatin, paroxetine, insulin, hydrochlorothiazide, and lisinopril. Three weeks previously he had completed a 10-day course of trimethoprim/sulfamethoxazole for an upper respiratory infection. Otherwise, he was taking no new medications. He was allergic to penicillin. He denied substance abuse, recent travel, or risk factors for human immunodeficiency virus (HIV) infection. He worked as an automobile painter, lived with his wife, and had a pet dog.Physical examination revealed a well-appearing man with normal vital signs. His skin had well-defined circumscribed pink plaques, mostly 1-2 cm in size, with thick, silvery scales in the ears and on the dorsal and ventral arms and legs, chest, back,

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“…Auf T1-gewichteten Sequenzen kann die Myositis häufig nur kontrastmittelunterstützt detektiert werden. Aufgrund der hohen Sensitivität der MRT dient sie neben dem Elektromyogramm zur topographischen Erfassung und Benennung des Kennmuskels zur diagnosesichernden Muskelbiopsie [19].…”

Section: Muskuloskelettalunclassified

Bildgebung bei Kollagenosen

Ostendorf

Cohnen²,

Scherer³

2006

Z. Rheumatol.

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Guidelines and diagnostic algorithms for the introduction of diagnostic procedures for connective tissue diseases have not yet been established and standardized. Diagnosis is often based on the patients's typical history, clinical symptoms and specific laboratory profiles. The use of diagnostic imaging procedures is relevant for differential diagnosis, for the assessment of disease activity and organ involvement, for defining the prognosis and monitoring responses to therapy and side effects. Experience with these techniques and diagnostic procedures, their application, indications and analysis represent the platform for rational and optimal diagnosis as well of defined therapy stratification.

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Utility of magnetic resonance imaging in the evaluation of patients with inflammatory myopathies

Cited by 60 publications

References 46 publications

Quantitative evaluation of muscle perfusion with CEUS and with MR

Quantitative evaluation of muscle perfusion with CEUS and with MR

“Are we there yet?”

Bildgebung bei Kollagenosen

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